MICHIGAN ORTHOPAEDICS AND SPORTS MEDICINE, PC (NPI# 1932174109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932174109 |
| Entity Type | Organization |
| Organization Name | MICHIGAN ORTHOPAEDICS AND SPORTS MEDICINE, PC |
| Practice Address |
2911 Knapp St Ne Suite A Grand Rapids MI 49525 |
| Practice Telephone | 6164519925 |
| Practice Fax Number | 6164519896 |
| Mailing Telephone | 6164519925 |
| Mailing Fax Number | 6163285380 |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2012-10-17 |
| Authorized Official Name | DR. KYLE ROBERT RANDALL (PRESIDENT) |
| Authorized Official Telephone | 6164519925 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
2911 KNAPP ST NE SUITE A |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881691962 | Jerome Daniel Broderick | Physical Therapist | 2911 Knapp St Ne, Suite C, Grand Rapids, MI 49525-4600 | 2005-07-05 |
| 1275762973 | Kara Jo Schipper | Physical Therapist | 2911 Knapp St Ne, Suite C, Grand Rapids, MI 49525-4600 | 2009-07-02 |
| 1871677294 | Achieve Physical Therapy and Sports Rehab, LLC | Physical Therapist | 2911 Knapp St Ne, Suite C, Grand Rapids, MI 49525-4600 | 2006-10-24 |
| 1154396364 | Kyle Robert Randall | Orthopaedic Surgery | 2911 Knapp St Ne, Suite A, Grand Rapids, MI 49525 | 2006-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053928507 | Therapy With Nicole Pllc | Community/Behavioral Health | 4867 E. Beltline Ave. Ne, Building #1 Lower Level, Grand Rapids, MI 49525 | 2020-09-29 |
| 1184242760 | Christian Healthcare Specialists, Inc. | Obstetrics & Gynecology | 3322 Beltline Court Ne, Suite 1, Grand Rapids, MI 49525 | 2020-07-09 |
| 1174154645 | Amy Vanderslik | Case Manager/Care Coordinator | 3310 Eaglecrest Park Dr. Ne, Suite 100, Grand Rapids, MI 49525 | 2020-02-03 |
| 1477195246 | Epic Discoveries LLC | Counselor | 4867 E. Beltline Ave Ne, Grand Rapids, MI 49525 | 2019-10-14 |
| 1598228959 | Kim Scherencel Lmsw Counseling | Social Worker | 3280 Beltline Ne, Grand Rapids, MI 49525 | 2019-04-11 |
| 1821558958 | Mindful Trajectories | Social Worker | 3280 Beltlne Ct Ne, Grand Rapids, MI 49525 | 2019-03-24 |
| 1104380518 | Julianne Lettinga, Ma Lpc Counseling | Counselor | 3280 East Beltline Ct Ne, Grand Rapids, MI 49525 | 2019-01-30 |
| 1396227229 | Christopher Scot Doucette | Social Worker | 2064 Airway St Ne, Grand Rapids, MI 49525 | 2018-09-06 |
| 1568976017 | Amy K. Deyoung, Dds, Ms, PC Pediatric Dentistry | Dentist | 3297 Eagle Run Dr. Ne, Grand Rapids, MI 49525 | 2017-11-20 |
| 1407389604 | Kelly Jo Crabb | Social Worker | 4829 E Beltline Ave Ne Ste 100, Grand Rapids, MI 49525 | 2017-04-05 |
| Find all providers in zip 49525 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215075106 | Carl Henry Wierks | Orthopaedic Surgery | 1000 E Paris Ave Se Ste 215, Grand Rapids, MI 49546-3680 | 2007-02-02 |
| 1003909524 | Mfb Professional Services Inc | Orthopaedic Surgery | 1155 E. Paris, Ste 200, Grand Rapids, MI 49546 | 2006-10-02 |
| 1245331941 | James R Lebolt | Orthopaedic Surgery | 4100 Lake Dr Se, Ste 300, Grand Rapids, MI 49546-8292 | 2006-09-26 |
| 1578509303 | John H Healey Jr. | Orthopaedic Surgery | 350 Lafayette Ave Se, Fourth Floor, Grand Rapids, MI 49503-4656 | 2006-06-21 |
| 1730125428 | Timothy D Henne | Orthopaedic Surgery | 350 Lafayette Ave Se, 5th Floor, Grand Rapids, MI 49503-4656 | 2006-06-21 |
| 1720076219 | Peter C Theut | Orthopaedic Surgery | 1111 Leffingwell Ave Ne, Ste 100, Grand Rapids, MI 49525-6406 | 2005-10-10 |
| 1700873874 | Thomas M Matelic | Orthopaedic Surgery | 1111 Leffingwell Ave Ne, Ste 100, Grand Rapids, MI 49525-6406 | 2005-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821472861 | Oakland University | Orthopaedic Surgery | 201 Athletics Ctr, Rochester, MI 48309 | 2015-07-18 |
| 1689871576 | Stacy Ann Frye | Orthopaedic Surgery | 3960 Patient Care Dr Ste 113, Lansing, MI 48911-4279 | 2007-07-02 |
| 1598878266 | Abdallah Simaika | Orthopaedic Surgery | 2797 Applegate Rd, Po Box 55, Applegate, MI 48401-9752 | 2006-08-16 |
| 1689662405 | Richard M Howell | Orthopaedic Surgery | 370 N 120th Ave, Holland, MI 49424-2196 | 2005-10-06 |
| 1235121138 | Steven T Plomaritis | Orthopaedic Surgery | 28001 Schoenherr Rd, Suite 3, Warren, MI 48088-4396 | 2005-08-17 |
| 1457961716 | Justin Michael Schupbach | Orthopaedic Surgery | 24 Frank Lloyd Wright Dr Lbby A, Ann Arbor, MI 48105-9484 | 2020-08-03 |
| 1053945923 | Pure Performance Orthopedics & Sports Medicine | Orthopaedic Surgery | 27207 Lahser Rd Ste 108, Southfield, MI 48034-2168 | 2020-02-28 |
| 1396377131 | Msu Health Care Inc. | Orthopaedic Surgery | 4660 S Hagadorn Rd Ste 420, East Lansing, MI 48823-5353 | 2020-02-10 |
| 1477011591 | Shannon Elizabeth Manno | Orthopaedic Surgery | 26850 Providence Pkwy Ste 260, Novi, MI 48374-1256 | 2019-03-07 |
| 1659895993 | Alexander S Russell | Orthopaedic Surgery | 2799 W Grand Blvd, Detroit, MI 48202 | 2017-07-28 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49525 |
Please comment or provide details below to improve the information on MICHIGAN ORTHOPAEDICS AND SPORTS MEDICINE, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.